Welcome to the Illinois Health Matters Blog

Sunday, June 26, 2011

In 2010, a study conducted by the University of Illinois at Chicago showed that over 95% of Illinois’ kids had insurance coverage, making Illinois a state with one of the lowest rates of uninsured children in the nation. Much of this success can be attributed to the All Kids health insurance program, which provides for affordable, comprehensive health insurance for all Illinois children (up to age 19) who need coverage, regardless of family income or immigration status. Higher-income families pay monthly premiums ranging from $15 - $300/child, along with co-pays for doctor visits and other health care services.

Children enrolled in All Kids at or above 300% FPL by June 30th, 2011 are allowed to continue All Kids coverage for up to 12 months until July 1st, 2012, when NO children above 300% FPL will be allowed to continue their coverage.

While the Illinois Department of Healthcare and Family Services estimates that fewer than 4,000 children are enrolled in All Kids above the income cap, it’s likely that many of these families enrolled their children in All Kids because private insurance was unaffordable or inaccessible or because coverage options were insufficient for their child’s health care needs.

So where does this leave families who will no longer be able to qualify for All Kids?

Families can pursue employer-based insurance or insurance on the individual market. The Affordable Care Act included a provision, effective September 23, 2010, that no longer allows insurance companies to deny children health insurance because of pre-existing conditions.

However, these options may be unaffordable or inaccessible to many families. If this is the case for you or for a family you know, the Illinois Maternal and Child Health Coalition is interested in hearing your story. These stories can help us with advocacy efforts to persuade legislators to revise the changes to All Kids in upcoming legislative sessions. Contact Kathy Chan at kchan@ilmaternal.org or at 312-491-8161 x 24.

Thursday, June 23, 2011

Earlier this week, the Associated Press reported an alleged “glitch” in the new health care law, proclaiming it would allow some early retirees with Social Security benefits and other income to qualify for Medicaid in 2014. While we may agree or disagree with expanding Medicaid for a small population of 62-65 year olds with Social Security benefits we need to agree on one thing: this glitch is not a state budget problem.

What’s alarming about this reported glitch is that it will be used as ammunition – yet another example of a federal burden put on states that must be lifted through a radical restructuring of Medicaid itself. The call to action will be to convert Medicaid to a block grant and eliminate current requirements that states not restrict Medicaid eligibility through 2014, known as “maintenance of effort.”

You can see it starting to surface: in the AP article, the former governor of Utah characterizes this as adding “fuel to the fire” and references Washington rules that don’t make sense. The article also mentions governors “clamoring” for change. One can easily be left with the impression that Medicaid expansion in 2014 will lead to collapsing state budgets everywhere. Yet the pending expansion will have no impact on states’ bottom line at first, and very little thereafter.

So, let’s put this “state budget” issue to rest right now with actual facts:

Under current Medicaid, federal government and states share the costs of the program. Today, states pay anywhere from just over 25% to 50% of the cost. In 2014, funding for the Medicaid expansion will work very differently than the current funding formula: the expansion will be entirely paid for by the federal government for the first few years; states will pay a small percentage of the costs thereafter.

State Share of Cost for Newly Eligible Medicaid

Year

State Share

2014

0%

2015

0%

2016

0%

2017

5%

2018

6%

2019

7%

2020 and beyond

10%

It is disingenuous to pretend the 2014 Medicaid expansion will be an additional burden to states, or that the size or scope of state obligations will be at all similar. Addressing this “glitch” simply cannot be addressed by abandoning states’ obligation to Americans who rely on Medicaid as a health care safety net until health care reform through the Affordable Care Act is complete.

Tuesday, June 21, 2011

On June 17, Dr. Karin Rhodes and her colleague Joanna Bisgaier of the University of Pennsylvania released a report on access to subspecialty doctors by children covered by Medicaid in Cook County, Illinois. The authors also published an article about the study underlying the report in the New England Journal of Medicine.

Dr. Rhodes undertook and was paid for the study pursuant to a contract with the Illinois Department of Healthcare and Family Services, the state’s Medicaid agency. The study was part of the department’s compliance with a 2005 consent decree in the case of Memisovski v. Maram, which followed a 2004 federal district court ruling that the state was not in compliance with Medicaid Act requirements that children receive recommended levels of preventive care and treatment of diagnosed conditions, and that they receive care at least to the same extent as children covered by other forms of insurance.

Following the consent decree in Memisovski, Illiniois has undertaken very significant reforms of the primary and preventive care system for children on Medicaid. It improved the rates paid for office visits to primary care doctors and dentists, and it held the processing time for those services to a reasonable level, even during the recession (when all other state bills were being delayed for many months). It launched a statewide “medical home” initiative designed to match children up with primary care doctors, which has had considerable success. Other strategies to improve primary care have been launched, and the overall effort continues.

The consent decree was less specific with respect to access to specialty care to diagnose conditions or especially to treat diagnosed conditions. It provided that the department undertake a study to examine the extent of access problems, and it left the remedies for any such problems to be determined after the study was completed. However, Illinois was not idle on this front. It enacted a round of rate increases for some pediatric specialists, and it included children in a disease management program for people with chronic illness.

The study released last Friday, however, shows that there is a very serious problem with access to specialty care for children covered by Medicaid and other public insurance, particularly as compared to children covered by other forms of insurance (mostly employer-based private insurance). Using a “secret shopper” methodology, the investigators posed as parents seeking care for a child, saying in one call that the child’s coverage was Medicaid and in the next call that the same child’s coverage was Blue Cross Blue Shield PPO (which dominates the market in Illinois). The Medicaid-covered children had very significant disadvantages for almost all sub-specialties in both the ability to get an appointment and in the waiting time for the appointment if it was granted. The one exception was psychiatric care, where there was a severe access problem regardless of type of insurance.

At the time of the original court order and consent decree, Illinois authorities were dealing with an inherited problem resulting from decades of underfunding and neglect of access issues in the state’s Medicaid program. They have been working to comply with the decree and improve the program, in spite of the grinding recession-driven budget crisis in the state. Representatives of the children in the case look forward to working in cooperation with state authorities to find and implement solutions to these newly documented problems with specialty access.

Meanwhile, the study has resulted in media coverage, and some commentators are attempting to use it to bolster current attempts by conservatives to cut spending on Medicaid or relieve states of the duty to comply with Medicaid’s federal rules guaranteeing children access to all needed care. Medicaid is not “broke”; it is underfunded. The underfunding causes it to fall short on its ability to deliver the kinds of quality health care that, over the long term, would save money by supporting healthier people. And Medicaid is not “broken”; it is falling short of its full potential. It provides plenty of essential health care to millions of children, working adults, people with disabilities and seniors. Cutting them off of Medicaid would hurt them immeasurably. And starving the program of funds would only exacerbate the problems with access and the efforts to expand the health care workforce needed to provide adequate care to all beneficiaries. Just because there are flaws in the program does not mean the program must end for millions of beneficiaries. If we scrapped every governmental program that has flaws that need fixing, where would the armed forces, roads, or schools be? Medicaid is essential, but it can and should improve, especially on this issue of access to needed care.

Wednesday, June 15, 2011

Before last year, the number of young adults going without health insurance had reached crisis levels. In 2009, nearly 15 million young adults between the ages of 19 and 29 lacked health insurance, 4 million more than a decade earlier. After being covered as children, these young adults mostly lost coverage when they were kicked off their parents’ insurance plans after college or at age 20, 21 or 22, depending on the insurance company, or after they aged out of Medicaid or SCHIP programs. After losing that coverage, they could not afford to purchase their own insurance on the open market, being unemployed, in low-paying jobs without benefits or in school and without coverage.

Had it not been for the passage of the Affordable Care Act (ACA) last year, the number of uninsured young adults would have continued to grow. As an unemployed, recent college graduate, I would most likely have been one of the newly uninsured in 2010 or had to pay for drastically more expensive coverage on my own.

Thankfully, the ACA’s provision mandating that insurers allow children up to age 26 to remain on their parents’ insurance has allowed me and thousands of young adults like me to remain covered. It scares me to think about what would have happened had I been forced to remain uninsured after I graduated. I have only had minor medical problems over the last year, but an accident or other serious malady would have been financially ruinous. Even if I had foregone the treatment of a small problem to save money, the problem could have developed into a much larger one.

However, other young adults with more serious health issues have benefited from this ACA provision more than me. My friends who have remained on their families’ insurance and who have chronic conditions, especially mental health conditions, are particularly benefiting from not having to discontinue their care. Even those who might have been able to buy more expensive coverage if forced are benefiting from remaining on their parents’ plans and having to pay less.

Unemployment is already crippling both financially and psychologically, especially for the young; I am thankful that a lack of health insurance is less of a worry for my generation than it was before the ACA. The ACA will even continue to make coverage more affordable for my generation in the future with the expansion of Medicaid and the establishment of state health insurance exchanges. In my mind, expanding health insurance for young adults, especially allowing young adults to remain on parents’ plans, is one of the most significant achievements of the ACA and a demonstration of how health reform is already reshaping the healthcare landscape of America.

Friday, June 10, 2011

Ever since the Affordable Care Act was passed in 2010, opponents have thrown every attack they can think of against the wall, hoping something will stick. As attempts to repeal the law have failed, some of their arguments have become increasing laughable and, unfortunately, unconscionably reckless. For instance, these opponents now want you to believe that, in essence, small business owners do not want free money -- a mindboggling claim in these economic times.

Opponents, including groups that claim to represent small business, are taking aim at the small business tax credit in the ACA -- a provision allowing businesses with fewer than 25 employees that have average annual wages under $50,000 to get a tax credit of up to 35% of their health insurance costs beginning in tax year 2010. They say small businesses aren't using the credits because they don't provide enough of a benefit.

Poppycock.

I'm a small business owner. I founded ACI Interactive, an award-winning international e-commerce company that, after 10 years, I sold to the nation's leading retirement products company. My current company, Small Business Majority, is a nonpartisan, nonprofit organization that focuses on advocating for small business-friendly policies at the national and state levels. And small business owners like myself have a special name for tax credits: free money.

Politicians and spin-doctors with an ax to grind about healthcare reform argue that my small business colleagues don't like free money. They say these tax credits, which are available until 2017, have no practical utility. That's like claiming that people wouldn't pick up $100 they find on the sidewalk because it's not enough to cover their rent that month. The argument is simply ridiculous, but even more astounding is that some people, likely far removed from the day-to-day reality of running a small business, seem to think it's a valid point.

Let me set the record straight. Small businesses like free money, even if it's available for only a few years or if it comes from a president they don't agree with. And they especially like it when times are tough.

There is a problem, however: small businesses haven't been taking advantage of the tax credits -- not because they're turning their noses up at free money, but because they don't know the credits exist. We polled more than 600 small business owners nationwide and found that 57% weren't aware the credits were available. After learning of the credits, one-third of small business owners who don't currently offer insurance to their employees said they'd be more likely to do so because of them.

The IRS sent postcards to the 4 million small businesses eligible for a credit on their 2010 taxes; according to a report we released last year with Families USA, nearly 84% of all small business in the country would be eligible for a credit. But small business people work 80-hour weeks so it's understandable that they might not know all the details of the healthcare law, especially when those shouting the loudest and purporting to have small businesses' best interests at heart are actively advocating against the credits. That's a disgrace and a disservice to our nation's entrepreneurs who bust their hump every day to make ends meet, pay their employees and turn a profit in their chosen endeavor.

It's clear partisans in Washington care more about scoring political points than helping small business owners. The fact that they're waging their ideological war at the expense of our nation's chief job creators is shameful. Small businesses will help dig us out of this recession. We should be doing everything in our power to help them, no matter what end of the political spectrum we fall on.